Exploring the victim offender overlap among people with an intellectual disability.

BACKGROUND: While there is growing international evidence pointing to the increased risks of crime perpetration and victimisation for some people with an intellectual disability, the overlap between offending and victimisation (the victim-offender overlap) remains unclear. METHOD: This study utilised a data linkage methodology of 2600 people with an intellectual disability, exploring their contacts with public mental health services and the police in Victoria, Australia. RESULTS: Victim-offenders accounted for a small proportion of the sample (n = 148, 5.7%). The victim-offender overlap was evident for both violent and nonviolent nonsexual crimes, particularly for theft, burglary, and threat-related crimes. Key differences were also noted between males and females. CONCLUSIONS: People with an intellectual disability who are both victim and offenders comprise a small but particularly complex justice-involved population. Future research should explore the victim offender overlap for males and females separately, as well as any additional risks and vulnerabilities associated with specific mental health diagnoses.

Crime and victimization among people with intellectual disability with and without comorbid mental illness.

BACKGROUND: Accumulating evidence internationally points to an increased risk of crime perpetration and victimization among people with an intellectual disability (ID). This study aimed to examine the impact that comorbid mental illness had on the association between intellectual disability, crime perpetration and criminal victimization. METHOD: A case linkage methodology involving 2,220 individuals with an intellectual disability from an Australian State. RESULTS: One in four (27%) had contacts with public mental health services; 8.2% had a comorbid mental illness. This "dual disability" group was between 2.97 and 3.22 times more likely than those with intellectual disability alone to have a history of criminal charges, and between 2.76 and 2.97 times more likely to have been a victim of crime. CONCLUSIONS: The extent of criminality and victimization found among people with dual disability indicates a potentially multiply stigmatized group for whom the need for a coordinated cross-agency service response remains paramount.

A pilot study exploring mental health consumers' experiences with the police.

Police encounters with people experiencing mental illness are both common and problematic. While there is an international body of literature on police officers' perceptions of mental-health-related incidents, few studies have sought to understand these encounters from the perspectives of people experiencing mental illness. This pilot study recruited 26 people through a state-wide Consumer Advisory Group who completed an online survey regarding their encounters with police. Results indicated that when people perceived procedurally just treatment from police they were more likely to co-operate with them and to evaluate the encounter positively. The nature of police involvement and levels of internalised stigma moderated the association between perceived procedural justice and their evaluation. Prior contacts were also important in shaping participants' overall attitudes towards police. Findings highlight the importance of officers treating people experiencing mental illness fairly and respectfully to facilitate peaceful encounters and help foster more positive perceptions of the police.

The risks, needs and stages of recovery of a complete forensic patient cohort in an Australian state.

BACKGROUND: Routine outcome measures are increasingly being mandated across mental health services in Australia and overseas. This requirement includes forensic mental health services, but their utility in such specialist services and the inter-relationships between the measures remain unclear. This study sought to characterise the risks, needs and stages of recovery of an entire cohort of forensic patients in one jurisdiction in Australia. METHODS: Local expert groups, comprising of members of the forensic patient treating teams, were formed to gather information about the status and needs of all forensic patients in the State of New South Wales, Australia. The expert groups provided demographic information and completed three assessment tools concerning the risks, needs and stages of recovery of each forensic patient. RESULTS: The cohort of 327 forensic patients in NSW appears to be typical of forensic mental health service populations internationally when considering factors such as gender, diagnosis, and index offence. A number of important differences across the three structured tools for forensic patients in different levels of secure service provision are presented. The DUNDRUM Quartet demonstrated interesting findings, particularly in terms of the therapeutic security needs, the treatment completion, and the stages of recovery for the forensic patients in the community. The CANFOR highlighted the level of needs across the forensic patient population, whilst the HCR-20 data showed there was no significant difference in the mean clinical and risk management scores between male forensic patients across levels of security. CONCLUSIONS: To the authors' knowledge this is the first study of its kind in New South Wales, Australia. We have demonstrated the utility of using a suite of measures to evaluate the risks, needs, and stages of recovery for an entire cohort of forensic patients. The data set helps inform service planning and development, together with providing various avenues for future research.

Striking the Right Balance: Police Experience, Perceptions and Use of Independent Support Persons During Interviews Involving People with Intellectual Disability.

BACKGROUND: Several jurisdictions mandate the presence of an independent support person during police interviews with vulnerable people. The current study investigated police officers' experiences and perceptions of these volunteers during interviews with people with intellectual disability(ies) (ID). METHODS: The sample comprised 229 police officers who attended a mandatory firearms training course in Melbourne, Australia, in 2010. RESULTS: Participants commonly reported utilizing independent support persons and displayed a fair understanding of their role. Overall, volunteers were engaged more frequently than family/friends; police considered the volunteers to be more impartial during interviews, whereas family/friends provided a greater level of emotional support to interviewees. CONCLUSIONS: Independent support persons need to demonstrate two quite different types of support to people with intellectual disability(ies) during police interviews; these require quite different skill sets and suggest the need for more tailored training and support for these volunteers. Implications for future research and policy are discussed.

Estimating the risk of crime and victimisation in people with intellectual disability: a data-linkage study.

PURPOSE: People with intellectual disability (PWID) appear more likely to be victims and perpetrators of crime. However, extant evidence pertaining to these risks is limited by methodological weaknesses and the absence of consistent operational definitions. This research aimed to estimate the prevalence of criminal histories and victimisation using a large, well-defined sample of PWID. METHODS: A case-linkage study was conducted comprising 2220 PWID registered with disability services in Victoria, Australia, whose personal details were linked with a state-wide police database. Criminal charges and reports of victimisation were compared to a non-disabled community comparison sample (n = 2085). RESULTS: PWID were at increased risk of having a history of criminal charges, particularly for violent and sexual offences. Although the non-disabled comparison group had a greater risk of criminal victimisation overall, PWID had a greatly increased risk of sexual and violent crime victimisation. CONCLUSIONS: PWID are at increased risk of victimisation and perpetration of violent and sexual crimes. Risk of sex offending and victimisation is particularly elevated, and signalling the need for specialised interventions to prevent offending and to ensure victims is assisted with access to justice, support, and treatment.

Crime and victimisation in people with intellectual disability: a case linkage study.

BACKGROUND: Studies have suggested that people with intellectual disability are disproportionately involved in crime both as perpetrators and victims. METHOD: A case linkage design used three Australian contact-level databases, from disability services, public mental health services and police records. Rates of contact, and official records of victimisation and criminal charges were compared to those in a community sample without intellectual disability. RESULTS: Although people with intellectual disability were significantly less likely to have an official record of victimisation and offending overall, their rates of violent and sexual victimisation and offending were significantly higher. The presence of comorbid mental illness considerably increased the likelihood of victimisation and offending; several sex differences were also noted. CONCLUSIONS: People with intellectual disability are at increased risk for both violent and sexual victimisation and offending. The presence of comorbid mental illness aggravates the risk of offending and victimisation. Future research should focus on a more nuanced exploration of the risks associated with intellectual disability and specific mental disorders and related indices of complexity.

Children's implicit recall of junk food, alcohol and gambling sponsorship in Australian sport.

BACKGROUND: In Australia, sport is saturated by the promotion of junk food, alcohol and gambling products. This is particularly evident on player jerseys. The effect of this advertising on children, who are exposed to these messages while watching sport, has not been thoroughly investigated. The aim of this research study was to investigate: (1) the extent to which children implicitly recalled shirt sponsors with the correct sporting team; (2) whether children associated some types of sponsors with certain sporting codes more than others; and (3) whether age of the children influenced the correct recall of sponsoring brands and teams. METHOD: This experimental study conducted in New South Wales, Australia used projective techniques to measure the implicit recall of team sponsorship relationships of 85 children aged 5-12 years. Participants were asked to arrange two sets of magnets - one which contained sporting teams and one which contained brand logos - in the manner deemed most appropriate by them. Children were not given any prompts relating to sporting sponsorship relationships. RESULTS: Three quarters (77 %) of the children were able to identify at least one correct shirt sponsor. Children associated alcohol and gambling brands more highly with the more popular sporting code, the National Rugby League compared to the Australian Football League sporting code. Results showed that age had an effect on number of shirt sponsors correctly recalled with 9-12 year olds being significantly more likely than 5-8 year olds to correctly identify team sponsors. CONCLUSIONS: Given children's ability to implicitly recall shirt sponsors in a sporting context, Australian sporting codes should examine their current sponsorship relationships to reduce the number of unhealthy commodity shirt sponsors. While there is some regulation that protects children from the marketing of unhealthy commodity products, these findings suggest that children are still exposed to and recall these sponsorship relationships. Results suggest that the promotion of unhealthy commodity products during sporting matches is contributing to increased awareness amongst children of unhealthy commodity brands. Further investigation is required to examine the extent and impact of marketing initiatives during televised sporting matches on children.

Bipolar disorder and criminal offending: a data linkage study.

PURPOSE: The current study explored criminal offending among people diagnosed with bipolar disorder with and without comorbid substance use and compared this with a community sample with no history of bipolar disorder. METHODS: A case-linkage design was used to compare patterns of officially recorded criminal offending between 1,076 people with bipolar disorder drawn from a state-wide psychiatric case register with a community comparison group. RESULTS: Those with bipolar disorder were significantly more likely than community members to be charged with, convicted of, and be found guilty of, violent, non-violent and intermediate level criminal offences. Those with a comorbid substance use disorder were two times more likely than those without a substance use disorder to offend; both groups had a significantly higher chance of offending than the community sample. Females with bipolar disorder were significantly more likely to have been convicted of violent offences, irrespective of substance use. Significant interactions were found between bipolar disorder and substance use for males and females with respect to violent offending and for males with respect to non-violent offending. CONCLUSIONS: There is a statistically significant association between bipolar disorder and the likelihood of having a criminal history. Co-occurring substance use differentially impacts on the likelihood of criminal offending for males and females.

Estimated rates of mental disorders in, and situational characteristics of, incidents of nonfatal use of force by police.

PURPOSE: To examine the estimated rates of mental disorders and associated situational characteristics in people involved in nonfatal use of force incidents with police in VIC, Australia. METHODS: A random sample of 4,267 cases between 1995 and 2008 from a dedicated police Use of Force Register were linked with the state-wide public mental health database and a police contacts database. Rates of ICD 9 and ICD 10 mental disorders recorded on the public mental health database were examined, as well as rates of criminal offending and the characteristics of force used by both parties. RESULTS: More than a third of people on whom the police resorted to using force (n = 1,621, 38%) had a history of mental disorder. Significant overrepresentations of the estimated prevalence of psychosis [12.5%, OR = 9.03, 95% CI (7.41, 11.01), p < 0.001] and schizophrenia [9.1%, OR = 9.73, 95% CI (7.59, 12.47) p < 0.001] were found. Those diagnosed with mental disorders were 1.52 times more likely to use or threaten to use weapons on police, even after taking into account age, sex, substances intoxication and violent behaviour [95% CI (1.23, 1.91), p < 0.001]; however, they were no more likely to injure or be injured by police than those without a recorded history of mental disorder. There was a noted trend for police to use, or threaten to use, weapons on people with a history of psychosis (other than schizophrenia) [OR = 1.40, 95% CI (1.11, 1.78), p = 0.005]. CONCLUSIONS: Psychoses and schizophrenia are dramatically overrepresented in cases where police resort to using force. Situational characteristics evident in the encounters are suggestive of a sub-group of people with mental disorders presenting with aggressive and otherwise problematic behaviours coupled with histories of criminal offending; this presents significant ongoing challenges for the police.

A critical review of research into mental health consumers' perspectives on their physical health: Is there an absence of consumers in the design, conduct, analysis and reporting of this research?

We conducted a critical review, using systematic methods, of the literature examining mental health consumer perspectives on their physical and mental health in academic research published between 2005 and 2021. This review examined the inclusion, extent, type and centrality of consumer perspectives regarding their mental and physical health. The search produced 1,865 papers from which 116 met the inclusion criteria. Studies predominantly focused on consumers' individual experiences of their physical and mental health, including but not limited to their understandings and experiences of medication and associated risk factors. They also captured some social aspects of mental health consumers' physical health, including factors that impacted individual agency, stigma, and social and interpersonal factors. Structural factors affecting physical and mental health, such as accessibility of services and financial constraints, were also identified. The review revealed that in comparison to clinician perspectives, the direct representation of consumer perspectives was lacking. Similarly, while clinician and carer perspectives on structural factors were investigated, the consumer perspective in this area was missing. The review also found few genuine codesigned or coproduced research studies. To better identify and respond to the health needs as prioritized by consumers, this paper argues it is imperative that future studies prioritize codesigned and coproduced research. It is argued that a focus on "services as provided" rather than "services as received" has contributed to a lack of progress in addressing the life expectancy gap for consumers. It is recommended that journals, ethics committees and research policy organizations develop guidelines and standards to inform best practice in research on consumer perspectives and experience and to support the implementation of codesigned and/or coproduced approaches in future research. Respecting and including consumers as equal partners in the research process will lead to more meaningful insights to inform policy and practice and reduce the life expectancy gap for people living with mental health concerns.

Mental illness among police fatalities in Victoria 1982-2007: case linkage study.

OBJECTIVE: The aim of the present study was to explore the mental health and offending histories for all cases that resulted in fatal use of force by Victoria Police between November 1982 and February 2007. METHODS: Forty-eight fatalities were extracted from the Use of Force (UoF) Register, and then linked with the mental health and police contacts databases. These data were supplemented, where necessary, with relevant information from Coronial Reports and an Office of Police Integrity Report. RESULTS: All but six cases had involved recorded histories with mental health and criminal justice systems before the fatal incident occurred. Rates of all Axis I disorders were significantly overrepresented, with estimated rates of psychosis and schizophrenia 11.3- and 17.3-fold higher than estimated rates in the general population (95% confidence intervals = 6.3-20.2 and 9.2-32.4, respectively). Although the number of fatalities has halved since inception of Project Beacon (32 before vs 16 after 1995), there has been no reduction in representation of mental illness among those fatally shot. CONCLUSIONS: The significant over-representation of Axis I disorders, including severe mental disorders of psychosis and schizophrenia, is of considerable concern for both the police and the mental health providers. Functional interagency partnerships and police training on how to interact with people in distress are recommended to address the overrepresentation of mentally ill persons in these encounters.

Psychiatric disorders and unmet needs in Australian police cells.

OBJECTIVE: To determine the prevalence of current psychiatric disorders and unmet needs in a sample of police cell detainees in Victoria. METHOD: A cross-sectional descriptive study was conducted, including data linkage with the Victoria Police database and the Victorian Psychiatric Case Register. In Melbourne, Australia, 150 detainees were recruited from two busy metropolitan police stations. Outcome measures included estimated rates of psychiatric disorders, using the Structured Clinical Interview for DSM-IV-TR, and individual needs, using the Camberwell Assessment of Need - Forensic Version. RESULTS: One quarter (n = 32, 25.4%) of detainees had a prior admission to a psychiatric hospital, and three quarters met current criteria for a diagnosable mental disorder. The most common disorders were substance dependence (n = 81, 54%) and mood disorders (n = 60, 40%). A third met diagnostic criteria for both a mental illness and a substance use disorder. The odds of being classified with mood (OR = 10.1), anxiety (OR = 2.2), psychotic (OR = 15.4) and substance use disorders (OR = 26.3) were all significantly higher in the current sample as compared with the general population. Detainees with a mental illness identified significantly more needs and significantly more unmet needs (e.g. psychological distress) than those who did not rate as having a current mental illness. CONCLUSIONS: There remains a pressing need to evaluate standardized screening tools for mental illnesses in police cells to provide timely access to assessment and treatment services. The need for functional interagency collaborations are highlighted and discussed.

Adolescent sexual offenders: the relationship between typology and recidivism.

Adolescent sexual offending represents an ongoing social, judicial, clinical, and policy issue for services. The current study investigated the characteristics, criminal versatility, and rates of recidivism of a cohort of 156 male adolescent sexual offenders who were referred for psychological assessments by the courts between 1996 and 2007 in Singapore. Analyses revealed that specialists (sex-only offenders; n = 71, M(follow-up) = 56.99 months, SD(follow-up) = 31.33) and generalists (criminally versatile offenders; n = 77, M (follow-up) = 67.83 months, SD(follow-up) = 36.55) differed with respect to offense characteristics (e.g., sexually assaulting familial victims) and recidivistic outcomes. Although both groups sexually reoffended at roughly the same rate (14.3% vs. 9.9%), consistent with their typology, significantly more of the generalists reoffended violently (18.2% vs. 1.4%), sexually and/or violently (27.3% vs. 11.3%), nonviolently (37.7% vs. 16.9%), and engaged in any further criminal behaviors (45.5% vs. 23.9%) during follow-up. Adjusting for total number of offenses and age at first sexual offense, Cox regression analyses showed that generalists were significantly more likely than specialists to reoffend violently (hazard ratio = 9.31; 95% confidence interval = 1.15-76.39). The differences between generalists and specialists suggest a valid typological distinction with a higher risk trajectory for the generalists. These findings therefore have important clinical implications for assessment, management, and intervention planning for adolescent sexual offenders.

Clinical validation of the CANFOR scale (Camberwell Assessment of Need-Forensic version) for the needs assessment of people with mental health problems in the forensic services.

INTRODUCTION: One of seven people admitted in prison has a diagnosis of a severe mental disorder and it is necessary to assess their needs. CANFOR was developed in 2004 to assess the specific needs of the forensic mental health services users. Adaptation and validation of CANFOR into Spanish was done and the psychometric properties were tested. METHOD: After translation and back translation, we administered the CANFOR to a sample of 90 users of the penitentiary mental health services in Catalonia. RESULTS: Inter-rater and test-retest reliability coefficients for each of the 25 domains were high: moderate to almost perfect (0,44 to 1). Regarding concurrent validity a negative correlation was found between GAF (p<0,01); LSP in all its subscales(p<0,01-p<0,05 ) and needs as assessed with CANFOR. CONCLUSIONS: the Spanish version of CANFOR retains the psychometric properties described in the original version. It has been proved that the Spanish version is valid and reliable, so it can be considered an optimal instrument for the assessment of needs of people with a severe mental disorder admitted in prison.

Perspectives on person-centred care for borderline personality disorder: a critical research agenda.

Borderline Personality Disorder (BPD) is a highly contentious psychiatric diagnosis with ongoing tensions over nomenclature, aetiology and treatment recommendations. This article examines a number of these tensions and assesses how greater attention to the voices of people living with BPD may help inform the delivery of new modes of person-centred care. To this end, we present a critical social science research agenda for investigating the experiences, social contexts and support needs of people living with BPD. We canvass issues pertaining to the diagnosis of BPD (including its name), the strongly gendered dimensions of BPD, and the pressing need to improve support for people living with this condition. Throughout our analysis, we indicate how critical interdisciplinary inquiry may drive new responses to these challenges. Our analysis is illustrated with reference to experiences of BPD recounted in two Australia-wide surveys conducted in 2011 and 2017. We argue that greater progress towards person-centred care requires novel forms of evidence grounded in critical social inquiry into experiences of treatment and support among people living with BPD, and the varied social, cultural and political contexts underpinning these experiences.

Factors associated with seclusion in a statewide forensic psychiatric service in Australia over a 2-year period.

Despite seclusion being described as one of the most ethically- and legally-controversial management options available, it remains a widely-used clinical strategy for managing disruptive, aggressive, and violent behaviour. This study sought to determine how frequently seclusion was used, the common characteristics of those secluded and not secluded, and the degree to which the Level of Service Inventory - Revised: Screening Version (LSI-R: SV) could predict seclusion. The study was retrospective, covering the first 2 years of operation of a statewide forensic psychiatry hospital in Victoria, Australia. Data were collected from individual case files, electronic databases, and paper copies of records pertaining to violent incidents and episodes of seclusion. Eighty five (44%) of the 193 patients admitted during this period were secluded. Those secluded were significantly younger and had a more established psychiatric history. LSI-R: SV scores were significantly and positively associated with being secluded. A statistical model containing three LSI-R: SV items, along with age on admission and psychiatric history, achieved an area under the curve of 0.74. Seclusion is used on a regular basis in response to a range of different forms of aggressive behaviour of different severity. The LSI-R: SV demonstrated moderate-to-good accuracy in predicting seclusion and warrants further research using detailed prospective methodologies.

Childhood Abuse and Delinquency: A Descriptive Study of Institutionalized Female Youth in Singapore.

Childhood abuse experiences appear prevalent in institutionalized children and youth, but research to date has been limited. Moreover, there is no published study that has examined the issue of childhood abuse and delinquency within institutionalized children and youth in Singapore. This study was cross-sectional in design with follow-up criminal record checks. Data were collected from multiple data sources including official records, structured clinical interviews, and self-report questionnaires on 79 adolescent female residential youth. Two thirds reported having experienced childhood abuse and a higher proportion reported having previously engaged in self-harming behaviours. Participants with multiple types of abuse reported being abused at a younger age, were more likely to be subjected to repeated physical abuse, to have overdosed on medication, and to have reported more health and sexual concerns and trauma symptomatology than those who reported either experiencing one or no previous types of abuse. Fourteen (18%) of the sample had been convicted of further criminal offences over a 6½-year follow-up. The adolescents with histories of multiple types of abuse in childhood presented with more health concerns and traumatic symptomatology, self-reported delinquency, as well as past self-harming behaviour during their institutional stay. Identification of these additionally vulnerable adolescents has important clinical implications for identification, assessment and intervention planning.

The reliability and validity of the forensic Camberwell Assessment of Need (CANFOR): a needs assessment for forensic mental health service users.

No instrument exists that measures the individual needs of forensic mental health service users (FMHSUs). The aim of this study was therefore to develop a valid and reliable individual needs assessment instrument for FMHSUs that incorporated staff and service user views and measured met and unmet needs. The Camberwell Assessment of Need was used as a template to develop CANFOR. Consensual and content validity were investigated with 50 forensic mental health professionals and 60 FMHSUs. Both were found to be satisfactory. Concurrent validity was tested using the Global Assessment of Functioning and a five-point needs scale, and again was found to be satisfactory. Reliability studies were carried out with 77 service users and 65 staff in high and medium security psychiatric services in the UK. Inter-rater reliability, rating whether a need was present or not, was high for service users (0.991) and staff (0.998). Similarly high reliability was found for unmet needs (0.985 and 0.972, respectively). Test-retest reliability was found to be moderately high for service users (0.795) and staff (0.852) when ratings were made two weeks apart. Similar levels were found for ratings of unmet needs (0.813 and 0.699, respectively). The average interview time was 23 minutes. CANFOR has good validity and reliability, and is suitable for further testing with other service user groups.

Harm associated with stalking victimization.

OBJECTIVE: The purpose of the present study was to determine the frequency at which assault and attempted assault occur as outcomes among stalking victims, and to explore the common characteristics of those cases in which the victims report these harmful outcomes as a result of the stalking behaviour. METHOD: A sample of 3700 men and women randomly selected from the electoral roll were sent a postal questionnaire to determine the prevalence and nature of their experiences of stalking behaviours. Those who self-reported that they had been stalked were divided according to whether their pursuer had, or had not, attacked them. RESULTS: Of the 432 who reported having been stalked, 75 (17.4%) had been attacked. A number of victim and perpetrator factors differentiated those who reported attacks. A combination of the victim being threatened, being an ex-intimate, and being younger at the time of the stalking incident were predictive of attack. A multivariate model containing these factors correctly classified 82% of the sample and achieved an AUC of 0.87. CONCLUSIONS: Stalking is an all too common problem behaviour that can result in a range of harmful outcomes for victims. Threats made by ex-intimates are a particular cause for concern. The generalizability of these findings should be tested using robust prospective methodologies in diverse populations.